Defining moments in men's lives : a study of personal narratives

This study explores the defining moments in six men’s lives. The empirical dimension of the research is built around the personal narratives these men tell of their lives across a series of four interviews. The central research theme is the notion of the defining moment as a key element in the processes of establishing how men understand and interpret the events and incidents that have shaped their lives. In the context of this study, the defining moment is seen as the moment or period in time when an individual gives definition to a specific event or experience, as a transition point with (potentially) life-altering consequences. Some of the thematic structures presented include relationships with significant adults (parents, teachers), masculinity, self-harm, schooling, mental illness, isolation, loneliness, stress and relationships with peers. In my pursuit of a methodology that could accommodate the aims of this study, I explored the process of meaning through the qualitative paradigm. Drawing on the principles of qualitative research, as applied through narrative inquiry, I deployed a semi-structured interview format to collect the lived experiences of participants. By privileging the stories that individuals tell of their experiences, the narrative method recognises that data are inexorably located in the contextual and contingent. The experiences and narratives that are presented in this thesis are built around the authentic voices of participants. The study presents a warrant for working with men’s defining moments to disrupt, alter and redefine their attitudes and behaviours in order to improve their lives. Based on the insights gleaned through this study, I argue that there are defining times/points in people’s lives where their experiences can be life altering. When these experiences involve uncertainty, anxiety, stress and other pernicious effects, their longer-term consequences can be devastating. The study confirms existing research, that men are reluctant to seek help or reveal their insecurities during such times, therefore making them particularly vulnerable to defining moments. The conclusion of this thesis establishes some broad recommendations pertaining to working effectively with men and their defining moments. I focus particular attention on the place of schooling and education in helping individuals recognise and respond to the early symptoms of what is potentially a life-altering experience. Schools and, by association, teachers need to be actively and strategically involved in this process. To this end, I argue the need for targeted interventions that are both sensitive and timely. In their engagements with young males, parents, teachers, coaches and mentors need to be particularly attuned to their silent screams for help.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

Envisioning Indochina : the spatial and social ordering and imagining of a French colony

The emergence of Indochina in the French imagination was articulated in both representational and institutional modes. Representation involves the transmission of colonial ideals through more obtuse means; that is, through literary texts, travelogues, exhibitions, film and advertising. However, these textual sites feed from and invest in a material situation, which was the institutional arm of colonialism. Indochina was institutionally articulated in cartographic maps and surveys, in the new social spaces of cities and towns, in architectural and technological forms, through social technologies of discipline and welfare and in cultural and religious organisations. The aim of this thesis is to analyse, across a number of textual sites, the representation and institutionalisation of Otherness through the politics of space in the French colony of Indochina, Indochine in this sense becomes a spatial discourse. The French constructed a mental and physical space for Indochina by blanketing and suffocating the original cultural landscape, which in fact had to be ignored for this process to occur. What actually became manifest as a result of this projection stemmed from the French imagination. Just as the French manipulated space, language also underwent the same process of reduction. The Vietnamese script was latinised to make it more 'useable' and ‘accessible’. Through christening the union of Indochina; initiating a comprehensive writing reform; and renaming the streets in the colonial cities, the French used language us another tool for 'making transparent'. Furthermore, the colonial powers established a communication and transport network throughout the colony in an attempt to materialise their fictive (artificial) vision of a unified French Indochinese space. The accessibility and design of these different modes of transport reflected the gendered, racial and class divisions inherent in the colonial establishment. At the heart of representing and institutionalising Indochina was the desire to control and contain. This characterised French imperial ordering of space in the city and the rural areas. In rural areas land was divided into small parcels and alienated to individuals or worked into precise grids for the rubber plantation. In urban centres the native quarter was clearly demarcated from the European quarter which functioned as its modern, progressive Other. The rationale behind this segregation was premised on European, nineteenth century discourses of race, class, gender and hygiene. Influenced by Darwinian and neo-Lamarkian theories of race, this biological discourse identified the 'working class', 'women' and 'the native' as not only biologically but also culturally inferior. They were perceived as a potential, degenerative threat to the biological, cultural and industrial development of the nation. In the colonial context, space was thus ordered and domesticated to control the native population. Coextensively, the literature which springs from such a structure will be tainted by the same ideas, and thus the spaces it formulates within the readers mind feed on and reinforce this foundation. Examples of gender and indigenous narratives which contest this imaginative, transparent topography are analysed throughout this thesis. They provide instances of struggle and resistance which undermine the ideal/stereotypical level of architectural and planned space and delineate an alternative insight into colonial spatial and social relations. The fictional accounts of European women and indigenous writers both challenge and reaffirm the fixity of some of these idealised colonial boundaries. In various literary, historical, political, architectural and cinematic discourses Indochina has been und continues to be depicted as a modern city and exotic Utopia. Informed by the mood of nostalgia, exotic images of Indochina have resurfaced in contemporary French culture. France's continued desire to create, control and maintain an Indochinese space in the French public imagination reinforces the multi-layered, interconnected and persistent nature of colonial discourse.

A cost-effectiveness analysis of the management of sore throat in children in Australia

For the first time a cost-effectiveness analysis of the management of sore throat in Australian children has been conducted using accurate epidemiological data generated from recent Australian studies.

Risk factors for chronic insomnia following hospitalisation

Aim. This paper reports a study whose purpose was to determine whether there is an increase in the incidence of chronic insomnia following hospitalization and, if so, to identify patients at risk.

Background. The consequences of difficulty sleeping in hospital have received scant attention from clinicians or researchers. Implicit in this lack of interest is the assumption that difficulty in sleeping is a transient reaction to hospitalization that will resolve on discharge, an assumption not empirically supported. It has been argued that in susceptible people this type of temporary disruption to sleep can be the catalyst for the development of chronic insomnia.

Method. Established sleep and depression rating instruments were used to monitor the sleep of 57 cardiac and 29 orthopaedic patients after elective surgery (n = 86), recruited through a hospital preadmission clinic.

Results. Preadmission chronic insomnia of 10% was consistent with general population prevalence estimates of 6–12%. Three months after discharge the incidence had almost doubled to 19%. Sixty-one per cent of this variance could be explained by hyperarousal, sleep hygiene issues, and dysfunctional cognitions about sleep. Depression was found to be a salient predictor but not an independent risk factor. Age, sex, and hospital-related data, such as score for difficulty sleeping in hospital, proved to be statistically insignificant.

Conclusions. The results support the role of hyperarousal and dysfunctional sleep attitudes and behaviours as stronger predictors of chronic insomnia than patient demographics or environmental issues. Given that most of the patients were ambivalent about how they slept in hospital, with high satisfaction (71%) in the presence of significant disruption (63%), preadmission sleep education given to these patients prior to admission potentially contributed to the development of more realistic expectations of the quality of in-hospital sleep.

Hexavalent chromium in welding fume

Evaluates the current Australian Standard method (AS3853.1) for the determination of total hexavalent chromium (Cr(VI)) in stainless steel welding fume. Investigates the extraction kinetics of this Cr(VI) into a range of media. Develops an analytical method for the determination of Cr(VI) in acidic extract solutions and investigates the extraction of Cr(VI) under simulated in vivo conditions.

Social ideological influences on food consumption and BMI

Social ideologies appeared to influence dietary behaviour, physical activity and BMI. These influences varied through different pathways in younger and older baby boomers. Studies provide insight into the segmentation of baby boomer population in relation to concrete social ideologies that could be used for policy development and effective health promotion.

Condom use

The thesis is based upon tests of a model for predicting condom use. Anticipation of negative emotions following unprotected intercourse was the strongest predictor of intention to use condoms. Interventions which encourage people to consider the emotions they would experience following unprotected intercourse may prove valuable in promoting condom use.

Dancing with death : risk, health promotion and injecting drug users

The thesis investigated ambivalent attitudes towards death in injecting drug users, factors that may lead to such ambivalent attitudes and implications for health promotion campaigns. It was found that this relationship with death was principally attributable to government drug policy in Australia.

Changes in antecedents of BMI between 1976 and 2006

Overweight/obesity has reached epidemic proportions in Australia. This thesis confirmed and extended the relationship between lifestyle and body mass index in that dense energy foods, snacking and low levels of physical activity were associated with higher BMI while plant foods, vegetarianism and, in men, large breakfasts were associated with lower BMI.

Physical activity for mothers of young children : perceptions of women and health-related professionals

This research develops understanding of women's perceptions and practices around physical activity when they are mothers of young children. The findings inform current approaches to promoting physical activity, helping to bring about better health outcomes for women, their families and the wider community.

Lay meanings and practices of medicinal use in a multicultural context : a qualitative study among Anglo-Celtic and Russian Australians in Melbourne

Describes medicinal use among Anglo-Celtic and Russian Australians. Cultural constructions of medicines are embedded in health beliefs; shaped by experiences with health care within socio-economic and political contexts. Cultural practices of medicinal use are best understood in the context of lay models of rationality and recognition of the conflict existing between the lay and expert models.

Rural women's self-management of arthritis

Assesses the relevance of self-management for rural women suffering arthritic conditions, by identifying factors that enabled or constrained their ability to self-manage, and by discerning differences between women in terms of their capacities to utilise self-management. A typology was developed identifying four different groups of rural women: unconstrained, passive, determined, and marginalised; therefore highlighting the ways in which different types of women are enabled or constrained in their self-management.

Building health promotion capacity in the workforce : participatory action research

This study used participatory action research to describe and analyse the elements of building health promotion capacity in a primary health care workforce in an urban community health setting, reinforcing the importance of provider informed evidence. It presents an integrated model for health promotion and capacity building in the workforce.