The nature and development of the general insurance industry in Australia to 1973

The development of the insurance industry in Australia in the twentieth century was fundamentally shaped by a collusive code of conduct called the tariff. This arrangement, established to overcome problems of uncertainty, initially benefited both tariff and non-tariff firms by enhancing market stability. It also reduced competition. The collusive agreements gradually broke down, however, as new entrants and products entered the market in the 1950s. Self-regulation gradually gave way as the 'rules of the game' changed. The result was a period of instability before new competitive practices, and more direct and specific regulatory requirements emerged in the 1970s.

Understanding barriers to attendance and non-attendance at Arts and Cultural Institutions: A Conceptual Framework

This paper draws together themes from within the leisure, arts and other literature related to why people might not attend cultural institutions and identifies eight barriers: 1) Physical; 2) Personal Access; 3) Cost; 4) Time and Timing; 5) Product; 6) Personal Interest; 7) Socialisation/Understanding; and 8) Information. Many of these barriers appear to be interrelated and as such strategies to address non-visitation will most likely need to be complex to allow the full range of barriers to be addressed.

Marketing cultural attractions : understanding non-attendance and visitation barriers

Purpose – The purpose of this paper is to draw together the previous academic and industry research on non-attendance of cultural attractions, followed by qualitative in-depth interviews to identify commonalities or gaps in the previous research on barriers, constraints and inhibitors, as well as to propose linkages between these.

Design/methodology/approach – A multi-method approach is used – where barriers, constraints and inhibitors are identified by means of thematic content analysis of the literature. A set of probing questions is developed based on these themes and is then examined in in-depth interviews with individuals that had not visited cultural attractions in the past two years, in an attempt to triangulate data, as well as to identify connections between barriers.

Findings – From the literature, eight interconnected barriers to visitation are identified: physical access; personal access; cost; time and timing; product; personal interest and peer group; socialisation and understanding; and information. The in-depth interviews generally support these, although it is also identified that there are complex interrelationships between the issues.

Originality/value – This paper addresses the neglected question of why people do not attend cultural attractions by triangulating thematic findings from the content analysis of diverse literature with in-depth interview responses from one non-visitor segment. This results in an interconnected model of barriers that can be used to assist managers to develop strategies addressing low visitation rates within targeted segments.

Public views of the benefits and barriers to the consumption of a plant-based diet

Objective: The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a plant-based diet. Design: Mail survey that included questions on perceived benefits and barriers to the consumption of a plant-based diet. Setting: Victoria, Australia. Subjects: Four hundred and fifteen randomly selected Victorian adults. Results: The main perceived barrier to adoption of a plant-based diet was a lack of information about plant-based diets (42% agreement). Sex, age and education differences were present in over a quarter of the barrier items. For example, non-university-educated respondents and older people were less willing to change their current eating pattern than were university educated and younger respondents. The main benefits associated with plant-based diets were health benefits, particularly decreased saturated fat intake (79% agreement), increased fibre intake (76%), and disease prevention (70%). Age, sex and education differences with regard to benefits were apparent, although sex differences were more important than age or education differences. Conclusions: The majority of respondents perceived there to be health benefits associated with the consumption of a plant-based diet. Compared with the proportion of respondents who agreed that there were particular benefits of eating a plant-based diet, perceived barriers were relatively low. An understanding of the perceived benefits and barriers of consuming a plant-based diet will help formulate strategies that aim to influence beliefs about plant foods, plant food consumption, and, ultimately, public health.

Bypassing luminal barriers, delivery to a gut addressin by parenteral targeting elicits local IgA responses

Induction of mucosal immunity, particularly to subunit vaccines, has been problematic. The primary hurdle to successful mucosal vaccination is the effective delivery of vaccine antigen to the mucosal associated lymphoid tissue. Physical and chemical barriers restrict antigen access and, moreover, immune responses induced in the mucosa can be biased towards tolerance or non-reactivity. We proposed that these difficulties could be circumvented by targeting antigen to the gastrointestinal associated lymphoid tissue via systemic (parenteral) rather than alimentary routes, using antibodies specific for the mucosal addressin cellular adhesion molecule-1 (MAdCAM). After intravenous or intramuscular injection of such rat antibodies in mice, we found a greatly enhanced (up to 3 logs) anti-rat antibody response. MAdCAM targeting induces a rapid IgA antibody response in the gut and vastly improves the systemic antibody response. Targeting also enhanced T cell proliferation and cytokine responses. Parenteral targeting of mucosal addressins may represent a generic technique for bypassing mucosal barriers and eliminating the need for adjuvants in the induction of proximal and systemic immunity.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

A practitioner's report on the interactive effects of socio-demographic barriers to travel

Researchers have viewed constraints as a subset of reasons for not engaging in a particular behavior. This study investigates the impact of two-way interactions between age, income, and life stage (forming groups of more and less constrained respondents) on dependent variables comprising intentions held by Australian residents to travel intrastate, interstate or overseas for a vacation. A representative sample of 49,105 Australian respondents is utilized. Binary logistic regression is used to profile respondents who intend to take a domestic or an overseas holiday of more than three days duration. This paper finds that the interactions between the constraint variables of age, income and life stage are important in explaining travel preferences. Constraint groups are then formed by combining the important constraint variables. There are significant levels of vacation travel by even the most constrained groups as well as significant amounts of non-travel by the least constrained sectors of our society. Marketing insights and recommendations are provided for the most constrained travel group and the least constrained travel group.

Effects of financial disadvantage on use and non-use of after hours care in Australia

Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.

Barriers to indigenous education and educational research reform in Australia

Across all Indigenous education sectors in Australia there continues to be extensive debate about the appropriateness of proposed assessment criteria, curriculum content, language of instruction, pedagogical approaches, research practices and institutional structures. Until relatively recently, policy initiatives targeting these issues have been developed and implemented separately and without reference to the interrelated nature of the barriers that confront Indigenous peoples in their attempts to challenge mainstream educational and research practices that potentially marginalise their individual and collective interests. Increasingly, these issues are being linked under the banner of 'Indigenous education reform', and the potential for collective Indigenous community action is being realised. The current Indigenous education reform process in Australia is concerned with reversing the trend associated with patterns of academic underachievement by Indigenous students in the nation's school systems. Concurrently, reforms in the area of Indigenous education research are concerned with achieving fundamental changes to the way Indigenous education research is initiated, constructed and practised. Mainstream institutions. Indigenous peoples and non-Indigenous peoples have different interests in the outcome of the resolution processes associated with proposals to reform Indigenous education and research practices. It is through investigation of stakeholder positioning in relation to key issues, and through reference to stakeholder interests in the outcome of negotiated resolutions, that a critical approach to analysing Indigenous education and research reform initiatives can be achieved. The three case studies contained within this portfolio represent an attempt to investigate the patterns of contestation associated with the delivery of primary school education for Aboriginal students in the Northern Territory and the problems associated with implementing reformed Indigenous education research guidelines. This research has revealed pervasive mainstream community and institutional support for assimilatory policies and a related lack of support for policies of Indigenous community 'self-determination1. This implies insufficient support within the Nation-State for Indigenous proposals for education and research reforms that legitimise the incorporation of Indigenous languages and cultural knowledge and that aim to re-position Indigenous peoples as central to the construction and delivery of education and educational research within their own communities. Common barriers to the implementation of reformed institutional structures and educational and research practices have been identified across each of the three case studies. The analysis of these common barriers points to a generalised statement about the nature of the resistance by mainstream Australians and their institutions to Indigenous community proposals for educational and research reforms. This research identifies key barriers to Indigenous Australian education and research reforms as being: Resurgent mainstream community and institutional support for assimilatory policies implies a lack of support for increasing the level of Indigenous community involvement in the construction and delivery of education and educational research; Mainstream institutional commitment to the principles of economic rationalism and the incorporation of corporate managerialist approaches reduces the potential for Indigenous community involvement in the setting of educational and research objectives; The education and social policy agendas of recent Australian governments are geared toward the achievement of national economic growth and the strengthening of Australia's position in the global economy. As a direct result, the unique cultural identities and linguistic heritages of Indigenous peoples in Australia are marginalised; Identified 'disempowenng' attitudes and practices of educators, researchers and institutional representatives continue to impact negatively upon the educational outcomes of Indigenous students; Insufficient institutional support for the development of mechanisms to ensure Indigenous community control over all aspects of the research project continues to impede the successful negotiation of research in Indigenous community contexts; The promotion of 'deficit' educational approaches for Indigenous students reinforces the marginalisation of their existing linguistic and cultural knowledge bases; The relationship between Indigenous and non-Indigenous peoples in Australia continues to be constrained by the philanthropically based 'donor-recipient' model of service delivery. The framing of Indigenous peoples as recipients of mainstream community benevolence has ongoing disempowering and negative consequences; Currently proposed national Indigenous education policies and programmes for the implementation of these polices do not adequately take into account the diversity in linguistic, political, cultural and social interests of Indigenous peoples in Australia; Widespread 'institutional racism' within mainstream educational institutions perpetuates the disadvantage experienced by Indigenous students and Indigenous community members who aim to derive benefit from education and educational research.

Exploring barriers to uptake of breast cancer screening in South East London : a study of women's views.

Research on both sides of the Atlantic demonstrates that achieving high uptake of breast cancer screening remains an important area of public heath concern. UK government targets for breast screening uptake are 70%, however, much lower figures are found in many parts of the country, including South East London. This paper reports the findings of a study carried out to explore the views of women aged 50 to 64 (the age group covered by the free National Health Service screening programme) in order to: · establish in what way women who do not attend for screening are different from women who do attend · ascertain the views of the non-attenders with a view to making recommendations to the service which may help address the low uptake locally.

305 women were recruited through a variety of different community sources across the study area. Using a structured questionnaire/interview, women gave their views on their health concerns generally, as well as on breast screening in particular. The analysis (being undertaken now, to be completed by May 2005) will explore the influence of candidacy (women's assessment of the personal risk to them of their disease) on women's screening behaviour and the differences, if any, between the major ethnic groups in the area, indigenous white, black African and black Caribbean.

Learning Objectives:
# At the conclusion of the session, participants will be able to

* 1. Describe the factors associated with women’s screening behaviour
* 2. Evaluate the relevance of candidacy in understanding screening behaviour
* 3. Assess the relevance of UK findings for screening programmes elsewhere.

Barriers experienced by Asians in accessing injury-related services and compensations

Introduction: The Accident Compensation Corporation (ACC) administers New Zealand’s (NZ) accident compensation scheme. Asians in NZ are apparently under-serviced by ACC and may be experiencing barriers to accessing services. This study identifies barriers that Asians in NZ face in accessing ACC’s injury-related services and compensations.

Methods: By utilising a qualitative research design, 113 Chinese, Korean, Indian, and South East Asian participants residing in Auckland, NZ were recruited through maximum variation and purposive snowball sampling. Data were gathered during 2006 through 22 individual in-depth interviews and 14 focus group discussions based on semi-structured interview schedules. Interviewees included Asian general practitioners, traditional health providers, users and non-users of injury-related services, case managers and Asian community leaders. Data were analysed using a general inductive approach.

Findings: Results show that personal/cultural characteristics such as age, gender, English language competence, injury-related language competence, differing Asian worldviews, and consequent help-seeking behaviours act as barriers to accessing services and entitlements. This is exacerbated by logistical and environmental factors such as cost, transport, time, inadequate interpretation and translation services, as well as institutional barriers such as lack of information about services, culturally inappropriate services, discriminatory attitudes and employment risks.

Conclusion: It is evident that Asians living in NZ are experiencing several cultural, environmental and institutional barriers to accessing ACC services. There is clearly a need for more culturally relevant information and injury-related services if Asian immigrants’ use of such services and entitlements is to be increased.

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Background In Australia there have been many calls for government action to halt the effects of unhealthy food marketing on children's health, yet implementation has not occurred. The attitudes of those involved in the policy-making process towards regulatory intervention governing unhealthy food marketing are not well understood. The objective of this research was to understand the perceptions of senior representatives from Australian state and territory governments, statutory authorities and non-government organisations regarding the feasibility of state-level government regulation of television marketing of unhealthy food to children in Australia.

Method Data from in-depth semi-structured interviews with senior representatives from state and territory government departments, statutory authorities and non-government organisations (n=22) were analysed to determine participants' views about regulation of television marketing of unhealthy food to children at the state government level. Data were analysed using content and thematic analyses.

Results Regulation of television marketing of unhealthy food to children was supported as a strategy for obesity prevention. Barriers to implementing regulation at the state level were: the perception that regulation of television advertising is a Commonwealth, not state/territory, responsibility; the power of the food industry and; the need for clear evidence that demonstrates the effectiveness of regulation. Evidence of community support for regulation was also cited as an important factor in determining feasibility.

Conclusions The regulation of unhealthy food marketing to children is perceived to be a feasible strategy for obesity prevention however barriers to implementation at the state level exist. Those involved in state-level policy making generally indicated a preference for Commonwealth-led regulation. This research suggests that implementation of regulation of the television marketing of unhealthy food to children should ideally occur under the direction of the Commonwealth government. However, given that regulation is technically feasible at the state level, in the absence of Commonwealth action, states/territories could act independently. The relevance of our findings is likely to extend beyond Australia as unhealthy food marketing to children is a global issue.

Regulation to create environments conducive to physical activity : understanding the barriers and facilitators at the Australian State Government level

Introduction Policy and regulatory interventions aimed at creating environments more conducive to physical activity (PA) are an important component of strategies to improve population levels of PA. However, many potentially effective policies are not being broadly implemented. This study sought to identify potential policy/regulatory interventions targeting PA environments, and barriers/facilitators to their implementation at the Australian state/territory government level.

Methods In-depth interviews were conducted with senior representatives from state/territory governments, statutory authorities and non-government organisations (n = 40) to examine participants': 1) suggestions for regulatory interventions to create environments more conducive to PA; 2) support for preselected regulatory interventions derived from a literature review. Thematic and constant comparative analyses were conducted.

Results Policy interventions most commonly suggested by participants fell into two areas: 1) urban planning and provision of infrastructure to promote active travel; 2) discouraging the use of private motorised vehicles. Of the eleven preselected interventions presented to participants, interventions relating to walkability/cycling and PA facilities received greatest support. Interventions involving subsidisation (of public transport, PA-equipment) and the provision of more public transport infrastructure received least support. These were perceived as not economically viable or unlikely to increase PA levels. Dominant barriers were: the powerful ‘road lobby’, weaknesses in the planning system and the cost of potential interventions. Facilitators were: the provision of evidence, collaboration across sectors, and synergies with climate change/environment agendas.

Conclusion This study points to how difficult it will be to achieve policy change when there is a powerful ‘road lobby’ and government investment prioritises road infrastructure over PA-promoting infrastructure. It highlights the pivotal role of the planning and transport sectors in implementing PA-promoting policy, however suggests the need for clearer guidelines and responsibilities for state and local government levels in these areas. Health outcomes need to be given more direct consideration and greater priority within non-health sectors.