Parenting, family functioning and lifestyle in a new culture : the case of African migrants in Melbourne, Victoria, Australia

This study documented the parenting styles among African migrants now living in Melbourne, Victoria, Australia, and assessed how intergenerational issues related to parenting in a new culture impact on family functioning and the modification of lifestyles. A total of 10 focus group discussions (five with parents and five with 13–17-year-old children; N = 85 participants) of 1.5–2 hours duration were conducted with Sudanese, Somali and Ethiopian migrant families. The analysis identified three discrete themes: (i) parenting-related issues; (ii) family functioning and family relations; and (iii) lifestyle changes and health. African migrant parents were restrictive in their parenting; controlled children's behaviours and social development through strict boundary-setting and close monitoring of interests, activities, and friends; and adopted a hierarchical approach to decision-making while discouraging autonomy among their offspring. Programmes seeking to improve the health and welfare of African migrants in their host countries need to accommodate the cultural and social dimensions that shape their lives. Such programmes may need to be so broad as to apply an acculturation lens to planning, and to assist young people, parents and families in addressing intergenerational issues related to raising children and growing up in a different social and cultural milieu.

Parenting, family functioning and lifestyle in a new culture : the case of African migrants in Melbourne, Victoria, Australia

This study documented the parenting styles among African migrants now living in Melbourne, Victoria, Australia, and assessed how intergenerational issues related to parenting in a new culture impact on family functioning and the modification of lifestyles. A total of 10 focus group discussions (five with parents and five with 13–17-year-old children; N = 85 participants) of 1.5–2 hours duration were conducted with Sudanese, Somali and Ethiopian migrant families. The analysis identified three discrete themes: (i) parenting-related issues; (ii) family functioning and family relations; and (iii) lifestyle changes and health. African migrant parents were restrictive in their parenting; controlled children's behaviours and social development through strict boundary-setting and close monitoring of interests, activities, and friends; and adopted a hierarchical approach to decision-making while discouraging autonomy among their offspring. Programmes seeking to improve the health and welfare of African migrants in their host countries need to accommodate the cultural and social dimensions that shape their lives. Such programmes may need to be so broad as to apply an acculturation lens to planning, and to assist young people, parents and families in addressing intergenerational issues related to raising children and growing up in a different social and cultural milieu.

Social stigma in diabetes : a framework to understand a growing problem for an increasing epidemic

A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.

The delivery of a telephone coaching programme to people with type 2 diabetes by practice nurses in Victoria, Australia : a qualitative evaluation

Aim.  To evaluate telephone coaching undertaken by practice nurses in a randomised controlled trial of self-management support for people with type 2 diabetes.

Background.  Qualitative evaluation of the processes that take place in randomised controlled trials has the advantage of providing information on those variables that contribute to the success or failure of the randomised controlled trial. This additional information can be used to improve or modify chronic disease management programme designs.

Methods.  Grounded theory was used to analyse transcriptions of telephone coaching sessions between practice nurses and patient participants in the randomised controlled trial.

Findings.   Analysis of transcriptions found that patient participants had complex multiple medical conditions to manage, as well as maintaining their daily lives. Two approaches to working with this complexity by practice nurses emerged. We characterised one as ‘treat to target’ and the other as ‘personalised care’. While each approach shapes identities available to patients within the relationship with the practice nurse, the impact or effectiveness of these approaches on outcomes has yet to be reported.

Conclusions.  Telephone coaching takes place in complex social contexts as well as complex medical conditions. People with type 2 diabetes must manage their diabetes care and their care of other conditions within their social contexts. This means a constant negotiation of priorities.

Relevance to clinical practice.  Awareness of how health professional support for patients’ self-management becomes a relationship and element of the negotiated identity of patients is important in adapting clinical guideline-based protocols to achieving targets in the management of chronic illness.

Measuring the social inclusion of people with a disability in Australia : the first national 1-in-4 poll

 Measuring social inclusion of people with a disability in Australia: the first national 1-in-4 poll. Moore, M; Hagiliassis, N; McGillivray, J; Wilson, E; Campain, R; Graffam, J. & Bink, M. The ‘1-in-4 poll’ is a regular survey of people with a disability in Australia, beginning in 2010. Each survey will deal with a different topic with the first survey focusing on social inclusion. Social inclusion means being included in a society where we feel valued, and can participate in work, social and cultural activities. This conference paper explains how the first survey was developed. This involved looking at information from other research about the social inclusion of people with disability in Australia compared with the general population. Most surveys to date lack information about people with a disability. Our survey draws on questions asked in other surveys and will enable a better understanding of social inclusion for people with disability in Australia. This conference paper will also report on the problems and solutions of developing a survey that is easy to use and meaningful to a large population of people with a disability including people with an intellectual disability. This survey instrument will enable people with a disability to have a say about their social inclusion. There are three versions of the survey including an on-line version that works with a range of assistive technologies, an Easy English version with pictures, and a standard print version. Results from the survey will be shared with government with the aim of improving social inclusion for people with disability The conference paper shows how we have designed a survey that enables a very wide range of people with a disability to give information about their participation in society.

Learning between schools and hospitals – young people and a curriculum of (dis)connection

As noted in other papers in this volume, a group of health and education researchers and practitioners came together to further develop their understanding of the situation of young people, who were clients of The Royal Children's Hospital Education Institute in 2007 in Melbourne, Australia. The resultant research project, funded by the Australian Research Council Linkage Grant, aimed to understand young people's perspectives on who they are and what matters to them in relation to education connectedness, identity, social relationships, and experiences with professionals. The project team was aware of the persisting patterns of relationships between the hospital, schools, young people, and their families. They were also cognizant of the heavy emphasis in the research and professional literature on evidence from relevant family adults and from health and education professionals. The intention of this project was to put the young people at the centre a study with the stories they told through word and image. Identity issues and school connections framed the analytical work. Thirty-one adolescents dealing with chronic illness participated in this longitudinal qualitative study for a 3-year period of their lives. Given the apparently active role of teachers and health professionals in the lives of these young people, the researchers wanted to include the various relevant adults to see what coherence or lack of coherence existed in the categories, emphases, and values they expressed compared with those of the young people. The researchers have had to determinedly keep their focus on the data from the young people and not be seduced by the familiar and readily accessible data from these professionals. Nonetheless, this data set does provide a ‘curriculum conversation’, which is profitably read behind the stories of the young people and in the foreground of new pathways of curriculum construction. It is this data which informs the work reported in this paper and which has led the researchers to resist the rhetoric of currently held story lines in this field, to see beyond the present hierarchies of power over relevant ‘knowledges’, to maintain a dual focus with the young people at centre stage and the professionals as ‘walk ons /extras’ and to argue for a ‘curriculum of connection’ between young people and the relevant education and health professionals. These issues are readily engaged in arguments for change through the interweaving of larger discourses of inclusivity, curriculum, and policy. This paper works those intersections in the everyday positionings of professionals and young people.

Intergenerational differences in food, physical activity, and body size perceptions among African migrants

We assessed intergenerational differences in food, physical activity, and body size perceptions among refugees and migrants from the Horn of Africa living in Victoria, Australia. We used a qualitative design and obtained data from 48 participants (18 individual interviews; 3 semistructured focus groups). Three major themes emerged: (a) food and physical activity, (b) preference of body size and social expectations, and (c) perceived consequences of various body sizes. For parents, large body size was perceived to equate with being beautiful and wealthy; slimness was associated with chronic illness and poverty. Parents adopted strategies that promoted weight gain in children. These included tailored food practices and restricting children’s involvement in physical activity. For young people, slimness was the ideal body size endorsed by their peers, and they adopted strategies to resist parental pressure to gain weight. Obesity-prevention programs in this subpopulation need to adopt a multigenerational approach.

A longitudinal examination of burden and psychological distress in carers of people with an eating disorder

Purpose
Eating disorders are chronic conditions that require ongoing, high level care. Despite the chronic nature of eating disorders, to date, previous research examining eating disorder carer burden and psychological distress has been cross-sectional only. Therefore, the current study aimed to conduct a preliminary longitudinal examination of the predictors of carer burden and psychological distress for carers of those with an eating disorder.
Methods
A self-report, quantitative questionnaire approach was utilised. Forty-two carers completed three self-report questionnaires over a period of 9 months (initial, 4½ and 9 months) assessing carer burden, psychological distress, carer needs, expressed emotion, coping strategies and social support.
Results
Maladaptive coping, expressed emotion and carer needs were significant longitudinal predictors of carer burden. Carer psychological distress could not be predicted longitudinally.
Conclusions
In order to reduce carer burden, interventions should test whether reducing maladaptive coping strategies, expressed emotion and addressing carer needs lead to lower carer burden and distress.

Promoting social inclusion of frail older people living in the community

The increasingly diverse needs and wants of Australia's ageing population, like those in many other societies, are drawing attention to aged care as an increasingly important area of broader health and social policy. Active qgeing and a focus on enabling people to remain living in their own homes in the community are two of the key components of this policy shift.

The policy shift towards active ageing recognises and aims to support the desires of older people to remain active members of their communities as they age. Active ageing is 'the process of optimising opportunities for physical, social and mental wellbeing throughout the life-course, in order to extend healthy life expectancy, productivity and quality oflife in older age' (AIPC 2008: 26).

According to the World Health Organization (WHO), the rights, needs, preferences and capacities of older people should be central to active ageing policies, and these should be framed by a life-course approach to ageing (WHO 2002). The development of age-friendly communities, social inclusion and engagement are emerging as key policy issues in the context of an ageing population.

Recent research demonstrates the importance of a sense of belonging in maintaining a sense of identity and increasing the wellbeing of an individual. The sense of belonging that comes about through community engagement also plays a role in successful adjustment to ageing, including prolonging good health and reduced risk of entry into residential aged care.

African culturally and linguistically diverse communities’ blood donation intentions in Australia: integrating knowledge into the theory of planned behavior

Background 

“I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes

Abstract
Objectives While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma.

Design A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis.

Setting This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes.

Participants All adults aged ≥18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years).

Results A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants’ unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation.

Conclusions Our study found evidence of people with T2DM experiencing and perceiving diabetes-related social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabetes