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In today's climate of consumer consultation in the development of client sensitive hospital and community based services, some voices have remained silent. Among this group are disabled children and young people, who receive professional care in a climate of 'in their best interest', firmly based on notions of abnormality and the inherent tragedy of disability. New paradigm childhood research and the social model of disability provide the theoretical framework for this qualitative study into the health and health care experiences of disabled children and young people. Both approaches demand a flexible and participatory approach in order to challenge the traditional relations of research production. Twenty young people aged 9-18 years met with the researcher up to four times, with a choice after the initial meeting of individual or group meetings. All had a physical disability, some also had communication or learning difficulties. Conversations with the young people covered a range of topics. The obvious ones related to hospitals, appointments, splints and therapy. About what it is like having a carer. Commonly held assumptions that hospitalisation is a significant feature of disabled childhoods is challenged by the data, appointments however reflect an ongoing surveillance. The young people spoke of experiences of empowerment and of powerlessness within a triad of parent:professional:young person. Concern that many treatments are an experiment and that outcomes are hard to balance with the pain and inconvenience of surgery or therapeutic devices raises questions regarding professional versus young person's definitions of success. It also demands debate regarding how much remedial intervention is enough. This is a difficult issue in a medical and social climate that idealises normality, but normality is not often an option. Health care constitutes only a narrow perspective of health and made up only a part of the discussion. It is the day to day health experiences that are more prominent in the lives of participants than intermittent professional services. The young people showed a recognition of factors that contributed to their health and sense of well being. Commonly the talk was about living in a world that considers them as different and the effect that has on them. These young people are making links between racism and their own disability experience, however they have no contact with disabled adults, some with no other disabled young people and no understanding of disability history or politics. This lack became even more evident when the participants talked about who understands what their life is like, of role models, realistic aspirations and dreams for quiet moments. School issues raised concerns such as equity in access, being different, having to prove oneself, limited school sport involvement and issues of friendship and teasing. One very powerful finding is that just like anyone else they are all different but that stereotypes of disability limit the lives of disabled young people and influence the responses of other people to them. This demanded from the researcher an interaction with the different experiences and responses to experiences of participants or risk creating another, albeit different stereotype. / thesis (PhD)--University of South Australia, 2001.

This thesis explores, through critical dialogue and personal experience, various aspects of rehabilitation in the context of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome. The journey visits broad, in principle, government policy reports. It touches on insurance and political aspects of health care; the separation between medical, convalescent and tertiary divisions of the rehabilitation professions; and, most importantly, it is concerned with the personal struggle to find some ‘meaning’ in the experience of a chronic illness for which there is, at this stage, no cure. From this arises the complexity of the inter-relationships between professionals and clients and the vexed question of ethics. The writing or methodology is first-person narrative, with deep roots in natural philosophy, and the dissertation can be read on several levels. It can also be read as a meta-thesis, that is, as an illustration of the process of researching/writing in an experiential methodology / Master of Science (Hons) Social Ecology

This research explores the international evolution of the policy of integration (formalisation) of traditional medicine in health care systems. This concept first arose on the policy agenda of the World Health Organisation in the 1970s and then re-emerged in 2002 (with alternative and complementary medicines). The history of this policy at the global level and its transfer to national levels over this period is analysed, via the content, scope and outcomes of policy and programme documents. This analysis emphasises the roles of context and stakeholders (specifically interest groups). The context in terms of the economic, political and social environment surrounding the development of the policy is considered, and held to offer a potential explanation as to how and why the policy agenda on integration was set and the manner in which programmes were formulated and implemented. Interest group interaction (competition for resources) is concluded to play a key role in explaining the development of this policy on an international level, and its problematic transfer to national levels. A case study of Sri Lanka explores national level implementation in greater detail. An analytical framework to analyse the development and implementation of this policy has been created, from a synthesis of anthropological and political science tools. The combination of several theories into an analytical framework allows this policy issue to be understood as an intrinsically political exercise that has been stimulated by global social and economic forces. The analytical framework developed offers another tool for the analysis and consequent understanding of the health policy process and thus may have relevance beyond the health policy issue of integration. / Doctor of Philosophy (PhD)

The juxtaposition of doing ‘more with less’, and ‘being privileged to be a community welfare worker’ gives some indication of the anomalies present in how community welfare work is conceived and manifested. The original contribution of this thesis is to provide further knowledge and understanding of the nature, level and extent of paucity management models to inform the way that community welfare services are delivered in rural communities. Paucity management relates to the way that managers identify and utilise strategies to counter the anomaly of possessing a deep philosophical underpinning in the value of community work, with the lack of means to meet all the needs and expectations of community members. Fifteen managers from the Central West Region of New South Wales in Australia were asked to share work narratives about the way their activities contributed to sustaining their communities. The research confirms yet again that community services are delivered strategically in spite of, or because of, a resource poor environment that is mainly punctuated by the non-availability of ever-decreasing funds. New ways of seeking resources has resulted in managers and workers navigating competing priorities at ground level, with trying to balance the tensions implicit in a directive provider-purchaser work dynamic that has seen the evolvement of the hybrid government organisation. This qualitative research used a phenomenographic approach to collect the managers’ stories. Data collection methods included individual interviews, focus group discussions, as well as further consultative communication. A complex theoretical framework, incorporating ideas from paucity management, aspects of structuration, and chaos/ complexity, was used to analyse the data through a structure of awareness of variation in the managers’ experiences. The findings show that community welfare managers do work in a resource poor environment, do acknowledge the presence of paucity management, and do address the limit-situations of service delivery through different, but complimentary, paucity management models that are creative, pragmatic, communicatively competent, and ‘auto-managed’. Their combined narrative gives a clearer understanding of the style of management that the managers used, as well as some of the strategies that contributed to ‘chameleon qualities’ of management. / Doctor of Philosophy (PhD)

The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered. The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.

This study investigated the influence of cultural change and acculturation on health-related help seeking behaviour of Vietnamese-Australians. Using convenience sampling, 94 Vietnamese-Australians, 106 Anglo-Australians, and 49 Vietnamese in Vietnam participated in the study. Beliefs about health and health-related help-seeking behaviours were assessed through measures of common mental health symptoms, illness expression (somatisation, psychologisation), symptom causal attributions (environmental, psychological, biological), and choice of help seeking (self-help, family/friends, spiritual, mental health, Western medicine, Eastern medicine).Vietnamese-Australian data was compared with that of the Anglo-Australian and Vietnamese-in Vietnam. Results revealed that the help seeking behaviours and health related cognitions of Vietnamese-Australians, while significantly different from those of Anglo-Australians, were similar to those of Vietnamese in Vietnam. Specifically, both Vietnamese groups were less likely than Anglo-Australians to somatise and psychologise or attribute the cause of symptoms to environmental, psychological or biological causes. However, the two Vietnamese groups were not different from each other in their style of illness expression or in their symptom causal attributions. The Vietnamese-Australians reported experiencing more mental health symptoms than the Vietnamese in Vietnam but fewer than the Anglo-Australians. In relation to help seeking, the Anglo-Australians chose self-help more than the Vietnamese, but there were few other differences between the cultural groups. To investigate the influence of acculturation on health-related beliefs and help seeking behaviour, Vietnamese-Australians were compared according to their modes of acculturation (integration, assimilation, separation, and marginalisation). Generally, results showed a distinct pattern of response. Those with high levels of acculturation towards the Australian culture (the integration and the assimilation) were found to be most similar (in that they scored the highest in most areas measured) to the Anglo-Australians, while few differences were found between the separated and the marginalised groups. Further, cultural orientation was a powerful predictor of help seeking. In that, original cultural orientation predicted selection of help seeking from Western and Eastern medicine, whereas, the host cultural orientation was a more robust predictor of the other variables. However, neither cultural orientation predicted preference for mental health help. Finally, the study found that, although the combination of symptom score, modes of illness expression, and symptom causal attribution were strong predictors of choice of help seeking of Vietnamese-Australians, acculturation scores further improved predictive power. The results were discussed in terms of the various limitations and constraints on interpretation of this complex data set.

Introduction - Eighty five per cent of Australians visit a GP each year, but do not receive all of the preventive care which is indicated for them. There have been no controlled trials of the effects of on-screen preventive care reminders in Australian general practice, and there is little published research examining characteristics of patients, doctors and consultations associated with the performance of preventive services in general practice. This study aimed to measure the effects of opportunistic reminders and to explore previously unexamined patient, GP and consultation factors associated with performance of preventive activities. The hypotheses were : a ) that general practitioners who were using a computer medical record system would take at least fifteen per cent more of opportunities to perform preventive care activities if they were reminded ; b ) that this would occur without any significant increase in the number of consultations or in patient billings ; and c ) that every characteristic of patients, GPs, consultations and preventive opportunities would be significantly associated with the performance of the preventive activities. Method - All patients who attended a ten GP fully computerised practice during one year were enrolled and randomised either to an intervention group, for whom the GPs received opportunistic on-screen reminders about eleven preventive activities, or to a 'usual care' control group. Performance by the GPs of the preventive activities was recorded automatically and correlated with routinely-collected demographic and clinical information about the patients and billing data. Results - For the intervention group compared to the control group, the GPs took thirty two per cent more of the preventive opportunities without any increase in numbers of services or in patient billings. Every characteristic of patients, GPs, consultations and preventive opportunities was independently associated with the performance of at least two of the preventive activities. Discussion - This trial has shown that a low cost minimally-intrusive intervention in the form of automated opportunistic reminder messages can significantly improve GPs' performance of preventive care activities. The findings of this trial may help to improve the design and effectiveness of opportunistic reminders in clinical software, and provide direction about possible changes to the health system which may foster increased provision of preventive care. / Thesis (Ph.D.)--University of Adelaide, School of Population Health and Clinical Practice, Discipline of General Practice, 2006.

This study was unique in that it focused on the rural elderly of both Black and White ethnicity's, explored differences between groups by comparing use and knowledge of health services, and controlled for gender, income, educational attainment, health status, age, and health beliefs - the independent variables of the study. Knowledge and use of health services were dependent factors. The Anderson behavioral model (Anderson, 1995) has been extensively used to examine health service utilization. It conceptualizes health care use as the outcome of a complex pattern of interactions between predisposing, enabling, and need-for care characteristics. The literature has supported the utility of the behavioral model for assessing the health care practices of rural older adults. Four questions were posed. These were translated into hypotheses for statistical testing purposes. Black and White elderly residents of one rural county in South Carolina comprised the target population. A sample of 150 elderly residents, 75 Black and 75 White, were randomly selected for participation. The multidimensional health locus of control scales were modified and used in the test instrument to assess health beliefs (both internal and external). Descriptive and background data were gathered from administration of the survey. Data were analyzed using SPSS statistical software. Analysis of variance (ANOVA) and the LSD (least significant differences) test, in addition to regression analysis, were used to compute and identify differences between and among groups of data. This research concluded that there was no correlation between use of services and knowledge of facilities. There were differences in utilization by race, with Whites making greater use of health care facilities. Educational levels, health status, income, household composition, type of insurance, and age influenced health care use. It was not influenced by gender, distance from facilities, and health beliefs. There was a statistically significant difference between knowledge and race, with Blacks having higher knowledge scores. Gender, health status, income, distance from facilities, and health beliefs did not influence knowledge. However, educational attainment, type of insurance, household composition, and age did. Service use and knowledge were adequate, in contrast to findings in the literature. Recommendations for further study were formulated. / Graduation date: 1999