Geelong community's priorities and expectations of public health care

Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.

Influences on preschool children's physical activity

This study explored mothers' perceptions of influences on preschoolers' physical activity. Six semistructured focus groups with 23 mothers were conducted across a range of socioeconomic position locations. Mothers identified 4 key areas of influence: child fundamentals (eg, sex, personality), parent power (eg, rules, support), people to share with (eg, peers, adults), and places and things (eg, physical environments, toys). No substantial differences in themes were identified among socioeconomic position groups. Influences on preschoolers' physical activity are multidimensional, multifactorial, and support the use of ecological models to conceptualize and understand the influencing factors. Associations among factors influencing preschoolers' physical activity should be further investigated through quantitative research.

Qualitative methods in early-phase drug trials : data and methods from a trial of N-acetylcysteine in schizophrenia

Objective: The pharmacokinetic profile of a drug often gives little indication of its potential therapeutic application, with many therapeutic uses of drugs being discovered serendipitously while being studied for different indications. As hypothesis-driven, quantitative research methodology is exclusively used in early-phase trials, unexpected but important phenomena may escape detection. In this context, this study aimed to examine the potential for integrating qualitative research methods with quantitative methods in early-phase drug trials. To our knowledge, this mixed methodology has not previously been applied to blinded psychopharmacologic trials.

Method: We undertook qualitative data analysis of clinical observations on the dataset of a randomized, double-blind, placebo-controlled trial of N-acetylcysteine (NAC) in patients with DSM-IV-TR–diagnosed schizophrenia (N = 140). Textual data on all participants, deliberately collected for this purpose, were coded using NVivo 2, and emergent themes were analyzed in a blinded manner in the NAC and placebo groups. The trial was conducted from November 2002 to July 2005.

Results: The principal findings of the published trial could be replicated using a qualitative methodology. In addition, significant differences between NAC- and placebo-treated participants emerged for positive and affective symptoms, which had not been captured by the rating scales utilized in the quantitative trial. Qualitative data in this study subsequently led to a positive trial of NAC in bipolar disorder.

Conclusions: The use of qualitative methods may yield broader data and has the potential to complement traditional quantitative methods and detect unexpected efficacy and safety signals, thereby maximizing the findings of early-phase clinical trial research.

Residents' perspectives on urinary incontinence : a review of literature

Background: Individuals in residential aged care facilities experience urinary incontinence more than any other single population. Despite these factors, the impact of the condition on their quality of life, their perspectives of living with the condition, and their preferences for care have received little research attention.

Aim: To provide a descriptive overview of research about; the impact of urinary incontinence on residents’ quality of life; residents’ perspectives of having urinary incontinence; and their preferences for continence care’.

Design: A descriptive review of literature.

Method: A broad search was undertaken for qualitative and quantitative research that evaluated residents’ quality of life related to urinary incontinence; their perspectives on having urinary incontinence, and their preferences for managing it. Data were displayed in tabular format, summarized, and described.

Results: Ten studies were identified and reviewed (six qualitative and four quantitative). They reveal many residents’ value having independent bowel and bladder function, but believe that incontinence in inevitable and intractable. Some adopt self management strategies, however considerable barriers hinder their ability to maintain continence and manage incontinence. Residents often have low expectations, and hence decline further evaluation and treatment. Some express satisfaction with continence care even if this care is not consistent with their preferences. Little is known about how cognitively impaired residents perceive their condition. However some individuals with cognitive impairment respond with acute anxiety when carers’ attempt to provide continence care.

Conclusion: Residents’ perspectives on incontinence and preferences for continence care relate to low expectations for improvement. Such misconceptions should be addressed and residents and their family members should be given a range of options from which to choose. As urinary incontinence impacts on residents’ quality of life, it is also important that continence care is delivered in a participative and sensitive way.

New cinema history and the computational turn

This paper outlines how the digitisation of both the film industry and contemporary research practices bear on the work of the new cinema historian. How might the opportunities presented by an unprecedented proliferation of data for example, also challenge the unspoken assumptions and ordinary practices of conventional film studies research? And how might the 'computational turn' present opportunities (and challenges) for a revisionist cinema history at the intersection of qualitative historiographies (focussed on the social experience of the cinema) and quantitative research approaches such as data mining, empirical analysis and digital visualisations?

Service quality in a higher education context : an integrated model

Purpose – The aim of this study is to develop and empirically test an integrated model incorporating the antecedents and consequences of service quality in a higher education context.

Design/methodology/approach – This research employed both qualitative and quantitative research methods. The data from three focus groups, conducted at the Central Queensland University (CQU), Rockhampton, Australia, generated key themes and their interrelationships. The theoretical model was then tested using structural equation modelling technique on a sample of 528 university students.

Findings – The findings show that information (marketing communications) is more statistically significant than past experience as the antecedents of service quality. The consequences of service quality are composed of trust, satisfaction, and image. Overall, the results suggest a good validity of the theoretical model and the key paths in the model are found statistically significant, except past experience affecting service quality.

Originality/value – The model provides a good explanation of a university brand image, and perceived service quality was found playing an important role in this model. Universities intending to enhance their image are encouraged to consider focusing their efforts on marketing communication information, service quality, student satisfaction and trust.

Phenomenology and the online : the importance of studying experience

 Phenomenological research into the online experience offers real value to Internet Studies and Digital Humanities scholars for three key reasons. Firstly, as an explicitly qualitative approach, it offers a way to gain insights into the experience of going online that are not identified by those who study behaviour alone. Secondly, as phenomenological studies focus on the individual rather than the collective, the resulting small sample size means that the investment required in terms of time spent with participants is minimised. Finally, the interpretation that emerges through the phenomenological research process produces categorisations that could form the basis on which larger scale, Big Data, quantitative research projects could be built.
This paper will explore the above ideas through the lens of my doctoral research, which uses hermeneutic phenomenology to investigate the experience of persona construction by artists on the fringes of the traditional art world, specifically craftivists, tattoo artists, street artists, and performance poets. By incorporating the interpretive categorisations that have come from my early discussions, I will demonstrate the strength of a phenomenological approach to investigating the experience of using the world and social media to present the self to the world.

Performance evaluation of e-government services using balance scorecard : an empirical study in Jordan

Purpose - the purpose of this paper is to emphasise on a balance between quantitative and qualitative measures, and examine the use of Balanced Scorecard to evaluate and estimate the performance of information and communication technologies (ICT) in delivering valuable e-government services through the internet. Design/methodology/approach - This study tests the hypotheses of e-government effectiveness using Balanced Scorecard technique by incorporating qualitative measures within a quantitative research methodology with data collected by means of a survey questionnaire. The survey sample of 383 stakeholders includes common customers, employees of e-government, and employees from the IT sector. The survey data were analysed to test the hypothesis in measuring e-government effectiveness from Balanced Scorecard's four dimensions: customer perspective, financial perspective, internal business process perspective, and innovation and learning perspective. Findings - The results show that the Balanced Scorecard factors fit very well with monitoring and measuring the performance of e-government in Jordan, and also in evaluating their success in IT project investments. Originality/value - This study attempts to address this gap in the literature and would benefit future studies in applying Balanced Scorecard for performance evaluation of various IT projects that are gaining huge investments from governments and organisations .

‘Waiting-to-see’ if the baby will come : findings from a qualitative study in Kafa Zone, Ethiopia

Background: Much of the quantitative research on maternal mortality in developing countries focuses on the need for health service interventions such as skilled attendants at birth and emergency obstetric and newborn care. A growing number of studies document the need for a more comprehensive perspective and include the macrostructural, that is, the social, cultural, economic and political determinants of health.
Objectives: To examine the salient aspects of birth at home and variables that influence decision making around transfer to a health facility during prolonged/obstructed labor.
Methods: Ethnography using participant observation and semi-structured interviews was conducted in 2007. A total of 56 mothers in Kafa Zone were selected: 20 in-depth interviews with women who gave birth at home; four who gave birth in a health facility; and 32 during antenatal care. Interviews were also conducted with health staff from Bonga Hospital and 15 health centers or health posts. Analysis followed a process of data reduction, data display and conclusion drawing/verification with the data organized around key themes.
Results: Most women gave birth at home assisted by their neighbor, mother, mother-in-law, or husband. It is likely women who gave birth at home feel ‘safe’ because that is where birth normally takes place and where they feel supported by close relatives and neighbors. Prolonged labor or ‘waiting-to-see’ if the baby would come was somewhat normalized and resulted in considerable delays to seeking assistance. Women felt it was ‘unsafe’ to go to a health facility because of the very real possibility that they would die on the way.
Conclusion: The findings highlight the importance of educating the local communities to recognize pregnancy related risks and to develop and implement appropriate responses, especially early referral, as communities play an important mobilizing role to health services.

Treatment seeking for vulvodynia and vaginismus: a systematic review

This systematic review synthesises the current literature regarding treatment seeking decisions in women with vulvodynia and vaginismus. A database search was conducted to identify literature of interest, including both qualitative and quantitative research. Of the 555 related articles, nine were deemed eligible. Findings suggest that treatment seeking can be a protracted process that has significant implications for women with vulvodynia and vaginismus. The women’s attitudes, perceptions and distress levels impact treatment seeking, with relationship factors and selfconcept affecting motivation for treatment seeking. Knowing what motivates treatment seeking could improve the rates of diagnosis and successful treatment, thus improving the quality of life for women with vulvodynia and vaginismus.

Advancing community engagement practice for strategic urban planning : learning from allied and remote disciplines

Urban planning has the potential to draw on allied and remote disciplines to improve community consultation processes for strategic planning projects. Urban design and landscape architecture have quantitative and qualitative methods which can be utilised to visualise different options of urban intensification which may fit within communities’ expectations of change. Furthermore political science has long used scientifically established psychometric techniques to collect data from broad sections of the population, analysing demographic profiles of communities and understanding their perceptions and attitudes. By appropriating quantitative and qualitative methods from other disciplines, urban planning policies can be developed which may reflect communities’ aspirations of amenity and neighbourhood character. The aim of this paper is to assist local government urban planners with their community engagement practice in order to form policies which are acceptable to the affected communities. The paper draws on Victoria as a case study of community engagement practice, examines research methods from allied and remote disciplines and proposes a community engagement framework which introduces rigour within the community engagement process.

Blokey' newsrooms still a battleground for female journalists

This paper reports on the largest survey of female journalists in the Australian news media. The goal was to investigate issues confronting women, including the extent of perceived gender discrimination in promotion, job segregation and working conditions. It is the first quantitative research of its type in 16 years, building on a smaller survey by the Australian media industry union, the Media, Entertainment and Arts Alliance (MEAA) and the International Federation of Journalists (IFJ). That 1996 report found there was significant gender discrimination in Australian newsrooms and that sexual harassment, in particular, was a systemic problem. This 2012 online survey of 577 female journalists working across all media platforms in metropolitan, regional, rural and suburban news media organisations demonstrates that little has changed. The paper compares and contrasts key data from the 2012 and 1996 surveys to ascertain the challenges still evident for female journalists.

Viewing the leadership narrative through alternate lenses: an autoethnographic investigation

This conceptual-theoretical article revisits the work of Parry and Hansen on the nature of the organizational story as leadership. The present article is written in the autoethnographic style. The original narrative work is re-examined through the lenses of autoethnography, narrative theory, metaphor/discourse, critical realism and conventional quantitative research. The insights provided by this methodological triangulation are examined. The conclusion is that organizational stories will reflect leadership if they are plausible to the intended audience, give all organizational members an empowered part in the story, have a moral to the story, and have a happy ending. The overarching theme that is proposed is of leadership as the generation of individual hope for a better existence.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies.

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

Parental practices encouraging and discouraging physical activity in Hong Kong Chinese preschoolers

Background: Regular participation in physical activity (PA) can help reduce the risk of overweight/obesity. Parental practices related to PA are modifiable determinants of preschoolers' PA that are still not well understood, especially in non-Western cultures. This qualitative explorative study aimed to identify parental practices encouraging or discouraging PA in Hong Kong preschoolers. Methods: Nominal Group Technique (NGT) sessions (n = 45; 6 to 9/group), complemented by a focus group (n = 6) and individual interviews (n = 12), were conducted with primary caregivers (mainly parents) of Hong Kong preschoolers to investigate what parents do to encourage (4 groups) and discourage (2 groups) PA in children. The groups were stratified by low and high neighborhood socioeconomic status. Results: Participants generated 21 and 16 items describing practices encouraging and discouraging preschoolers' PA, respectively. Parental provision of instrumental, motivational, and conditional support were thought to encourage child's PA, while parental safety concerns, focus on academic achievement, lack of time and resources, and promotion of sedentary behaviors were thought to discourage child's PA. Conclusions: Several parental practices that were deemed to encourage or discourage Hong Kong preschoolers' PA were identified. These can assist with development of a culturally sensitive scale of PA parenting practices and inform future quantitative research.