Support for patients with hepatitis C : An exploratory qualitative study of medical specialists’ perceptions

Objective: To explore the range of meanings about the role of support for patients with hepatitis C by examining medical specialists' perceptions. Method: The study employed a qualitative, open-ended interview design and was conducted in four major teaching hospitals in Adelaide, South Australia. Eight participants (three infectious disease physicians, four gastroenterologists, one hepatologist), selected through purposive sampling, were interviewed about general patient support, their role in support provision, the role of non-medical support and their reasons for not using support services. Results: Main themes included a focus on support as information provision and that patient education is best carried out by a medical specialist. The use of support services was defined as the patient's decision. Participants identified four key periods when patients would benefit from support; during diagnosis, failure to meet treatment criteria, during interferon treatment and following treatment failure. Conclusions: It was concluded that while barriers exist to the establishment of partnerships between specialists and other support services, this study has identified clear points at which future partnerships could be established. Implications: A partnership approach to developing support for patients with hepatitis C offers a systematic framework to facilitate the participation of health professionals and the community in an important area of public health.

Attitudes, Ideologies and Self-Organisation : Information Load Minimisation in Multi-Agent Decision Making

Sophisticated models of human social behaviour are fast becoming highly desirable in an increasingly complex and interrelated world. Here, we propose that rather than taking established theories from the physical sciences and naively mapping them into the social world, the advanced concepts and theories of social psychology should be taken as a starting point, and used to develop a new modelling methodology. In order to illustrate how such an approach might be carried out, we attempt to model the low elaboration attitude changes of a society of agents in an evolving social context. We propose a geometric model of an agent in context, where individual agent attitudes are seen to self-organise to form ideologies, which then serve to guide further agent-based attitude changes. A computational implementation of the model is shown to exhibit a number of interesting phenomena, including a tendency for a measure of the entropy in the system to decrease, and a potential for externally guiding a population of agents towards a new desired ideology.

A comprehensive investigation of the risky driving behaviour of young novice drivers

Young novice drivers - that is, drivers aged 16-25 years who are relatively inexperienced in driving on the road and have a novice (Learner, Provisional) driver's licence - have been overrepresented in car crash, injury and fatality statistics around the world for decades. There are numerous persistent characteristics evident in young novice driver crashes, fatalities and offences, including variables relating to the young driver themselves, broader social influences which include their passengers, the car they drive, and when and how they drive, and their risky driving behaviour in particular. Moreover, there are a range of psychosocial factors influencing the behaviour of young novice drivers, including the social influences of parents and peers, and person-related factors such as age-related factors, attitudes, and sensation seeking. Historically, a range of approaches have been developed to manage the risky driving behaviour of young novice drivers. Traditional measures predominantly relying upon education have had limited success in regulating the risky driving behaviour of the young novice driver. In contrast, interventions such as graduated driver licensing (GDL) which acknowledges young novice drivers' limitations - principally pertaining to their chronological and developmental age, and their driving inexperience - have shown to be effective in ameliorating this pervasive public health problem. In practice, GDL is a risk management tool that is designed to reduce driving at risky times (e.g., at night) or in risky driving conditions (e.g., with passengers), while still enabling novice drivers to obtain experience. In this regard, the GDL program in Queensland, Australia, was considerably enhanced in July 2007, and major additions to the program include mandated Learner practice of 100 hours recorded in a logbook, and passenger limits during night driving in the Provisional phase. Road safety researchers have also continued to consider the influential role played by the young driver's psychosocial characteristics, including psychological traits and states. In addition, whilst the majority of road safety user research is epidemiological in nature, contemporary road safety research is increasingly applying psychological and criminological theories. Importantly, such theories not only can guide young novice driver research, they can also inform the development and evaluation of countermeasures targeting their risky driving behaviour. The research is thus designed to explore the self-reported behaviours - and the personal, psychosocial, and structural influences upon the behaviours - of young novice drivers This thesis incorporates three stages of predominantly quantitative research to undertake a comprehensive investigation of the risky driving behaviour of young novices. Risky driving behaviour increases the likelihood of the young novice driver being involved in a crash which may harm themselves or other road users, and deliberate risky driving such as driving in excess of the posted speed limits is the focus of the program of research. The extant literature examining the nature of the risky behaviour of the young novice driver - and the contributing factors for this behaviour - while comprehensive, has not led to the development of a reliable instrument designed specifically to measure the risky behaviour of the young novice driver. Therefore the development and application of such a tool (the Behaviour of Young Novice Drivers Scale, or BYNDS) was foremost in the program of research. In addition to describing the driving behaviours of the young novice, a central theme of this program of research was identifying, describing, and quantifying personal, behavioural, and environmental influences upon young novice driver risky behaviour. Accordingly the 11 papers developed from the three stages of research which comprise this thesis are framed within Bandura's reciprocal determinism model which explicitly considers the reciprocal relationship between the environment, the person, and their behaviour. Stage One comprised the foundation research and operationalised quantitative and qualitative methodologies to finalise the instrument used in Stages Two and Three. The first part of Stage One involved an online survey which was completed by 761 young novice drivers who attended tertiary education institutions across Queensland. A reliable instrument for measuring the risky driving behaviour of young novices was developed (the BYNDS) and is currently being operationalised in young novice driver research in progress at the Centre for Injury Research and Prevention in Philadelphia, USA. In addition, regression analyses revealed that psychological distress influenced risky driving behaviour, and the differential influence of depression, anxiety, sensitivity to punishments and rewards, and sensation seeking propensity were explored. Path model analyses revealed that punishment sensitivity was mediated by anxiety and depression; and the influence of depression, anxiety, reward sensitivity and sensation seeking propensity were moderated by the gender of the driver. Specifically, for males, sensation seeking propensity, depression, and reward sensitivity were predictive of self-reported risky driving, whilst for females anxiety was also influential. In the second part of Stage One, 21 young novice drivers participated in individual and small group interviews. The normative influences of parents, peers, and the Police were explicated. Content analysis supported four themes of influence through punishments, rewards, and the behaviours and attitudes of parents and friends. The Police were also influential upon the risky driving behaviour of young novices. The findings of both parts of Stage One informed the research of Stage Two. Stage Two was a comprehensive investigation of the pre-Licence and Learner experiences, attitudes, and behaviours, of young novice drivers. In this stage, 1170 young novice drivers from across Queensland completed an online or paper survey exploring their experiences, behaviours and attitudes as a pre- and Learner driver. The majority of novices did not drive before they were licensed (pre-Licence driving) or as an unsupervised Learner, submitted accurate logbooks, intended to follow the road rules as a Provisional driver, and reported practicing predominantly at the end of the Learner period. The experience of Learners in the enhanced-GDL program were also examined and compared to those of Learner drivers who progressed through the former-GDL program (data collected previously by Bates, Watson, & King, 2009a). Importantly, current-GDL Learners reported significantly more driving practice and a longer Learner period, less difficulty obtaining practice, and less offence detection and crash involvement than Learners in the former-GDL program. The findings of Stage Two informed the research of Stage Three. Stage Three was a comprehensive exploration of the driving experiences, attitudes and behaviours of young novice drivers during their first six months of Provisional 1 licensure. In this stage, 390 of the 1170 young novice drivers from Stage Two completed another survey, and data collected during Stages Two and Three allowed a longitudinal investigation of self-reported risky driving behaviours, such as GDL-specific and general road rule compliance; risky behaviour such as pre-Licence driving, crash involvement and offence detection; and vehicle ownership, paying attention to Police presence, and punishment avoidance. Whilst the majority of Learner and Provisional drivers reported compliance with GDL-specific and general road rules, 33% of Learners and 50% of Provisional drivers reported speeding by 10-20 km/hr at least occasionally. Twelve percent of Learner drivers reported pre-Licence driving, and these drivers were significantly more risky as Learner and Provisional drivers. Ten percent of males and females reported being involved in a crash, and 10% of females and 18% of males had been detected for an offence, within the first six months of independent driving. Additionally, 75% of young novice drivers reported owning their own car within six months of gaining their Provisional driver's licence. Vehicle owners reported significantly shorter Learner periods and more risky driving exposure as a Provisional driver. Paying attention to Police presence on the roads appeared normative for young novice drivers: 91% of Learners and 72% of Provisional drivers reported paying attention. Provisional drivers also reported they actively avoided the Police: 25% of males and 13% of females; 23% of rural drivers and 15% of urban drivers. Stage Three also allowed the refinement of the risky behaviour measurement tool (BYNDS) created in Stage One; the original reliable 44-item instrument was refined to a similarly reliable 36-item instrument. A longitudinal exploration of the influence of anxiety, depression, sensation seeking propensity and reward sensitivity upon the risky behaviour of the Provisional driver was also undertaken using data collected in Stages Two and Three. Consistent with the research of Stage One, structural equation modeling revealed anxiety, reward sensitivity and sensation seeking propensity predicted self-reported risky driving behaviour. Again, gender was a moderator, with only reward sensitivity predicting risky driving for males. A measurement model of Akers' social learning theory (SLT) was developed containing six subscales operationalising the four constructs of differential association, imitation, personal attitudes, and differential reinforcement, and the influence of parents and peers was captured within the items in a number of these constructs. Analyses exploring the nature and extent of the psychosocial influences of personal characteristics (step 1), Akers' SLT (step 2), and elements of the prototype/willingness model (PWM) (step 3) upon self-reported speeding by the Provisional driver in a hierarchical multiple regression model found the following significant predictors: gender (male), car ownership (own car), reward sensitivity (greater sensitivity), depression (greater depression), personal attitudes (more risky attitudes), and speeding (more speeding) as a Learner. The research findings have considerable implications for road safety researchers, policy-makers, mental health professionals and medical practitioners alike. A broad range of issues need to be considered when developing, implementing and evaluating interventions for both the intentional and unintentional risky driving behaviours of interest. While a variety of interventions have been historically utilised, including education, enforcement, rehabilitation and incentives, caution is warranted. A multi-faceted approach to improving novice road safety is more likely to be effective, and new and existing countermeasures should capitalise on the potential of parents, peers and Police to be a positive influence upon the risky behaviour of young novice drivers. However, the efficacy of some interventions remains undetermined at this time. Notwithstanding this caveat, countermeasures such as augmenting and strengthening Queensland's GDL program and targeting parents and adolescents particularly warrant further attention. The findings of the research program suggest that Queensland's current-GDL can be strengthened by increasing compliance of young novice drivers with existing conditions and restrictions. The rates of speeding reported by the young Learner driver are particularly alarming for a number of reasons. The Learner is inexperienced in driving, and travelling in excess of speed limits places them at greater risk as they are also inexperienced in detecting and responding appropriately to driving hazards. In addition, the Learner period should provide the foundation for a safe lifetime driving career, enabling the development and reinforcement of non-risky driving habits. Learners who sped reported speeding by greater margins, and at greater frequencies, when they were able to drive independently. Other strategies could also be considered to enhance Queensland's GDL program, addressing both the pre-Licence adolescent and their parents. Options that warrant further investigation to determine their likely effectiveness include screening and treatment of novice drivers by mental health professionals and/or medical practitioners; and general social skills training. Considering the self-reported pre-licence driving of the young novice driver, targeted education of parents may need to occur before their child obtains a Learner licence. It is noteworthy that those participants who reported risky driving during the Learner phase also were more likely to report risky driving behaviour during the Provisional phase; therefore it appears vital that the development of safe driving habits is encouraged from the beginning of the novice period. General education of parents and young novice drivers should inform them of the considerably-increased likelihood of risky driving behaviour, crashes and offences associated with having unlimited access to a vehicle in the early stages of intermediate licensure. Importantly, parents frequently purchase the car that is used by the Provisional driver, who typically lives at home with their parents, and therefore parents are ideally positioned to monitor the journeys of their young novice driver during this early stage of independent driving. Parents are pivotal in the development of their driving child: they are models who are imitated and are sources of attitudes, expectancies, rewards and punishments; and they provide the most driving instruction for the Learner. High rates of self-reported speeding by Learners suggests that GDL programs specifically consider the nature of supervision during the Learner period, encouraging supervisors to be vigilant to compliance with general and GDL-specific road rules, and especially driving in excess of speed limit. Attitudes towards driving are formed before the adolescent reaches the age when they can be legally licensed. Young novice drivers with risky personal attitudes towards driving reported more risky driving behaviour, suggesting that countermeasures should target such attitudes and that such interventions might be implemented before the adolescent is licensed. The risky behaviours and attitudes of friends were also found to be influential, and given that young novice drivers tend to carry their friends as their passengers, a group intervention such as provided in a school class context may prove more effective. Social skills interventions that encourage the novice to resist the negative influences of their friends and their peer passengers, and to not imitate the risky driving behaviour of their friends, may also be effective. The punishments and rewards anticipated from and administered by friends were also found to influence the self-reported risky behaviour of the young novice driver; therefore young persons could be encouraged to sanction the risky, and to reward the non-risky, driving of their novice friends. Adolescent health programs and related initiatives need to more specifically consider the risks associated with driving. Young novice drivers are also adolescents, a developmental period associated with depression and anxiety. Depression, anxiety, and sensation seeking propensity were found to be predictive of risky driving; therefore interventions targeting psychological distress, whilst discouraging the expression of sensation seeking propensity whilst driving, warrant development and trialing. In addition, given that reward sensitivity was also predictive, a scheme which rewards novice drivers for safe driving behaviour - rather than rewarding the novice through emotional and instrumental rewards for risky driving behaviour - requires further investigation. The Police were also influential in the risky driving behaviour of young novices. Young novice drivers who had been detected for an offence, and then avoided punishment, reacted differentially, with some drivers appearing to become less risky after the encounter, whilst for others their risky behaviour appeared to be reinforced and therefore was more likely to be performed again. Such drivers saw t

Investing and reinvesting in social capital : the spill-over effects of social capital in self help groups

Part studies on the impact of microfinance through self help groups (HGs) and other collective poverty alleviation initiatives have predominantly focused on the financial benefits to the individual or the group (Hermes and Lensink 2011; Hulme and Mosley 1996). Such benefits are typically attributed to the financial capital made available to SHGs (Swain and Varghese 2009) and the social capital which accrues through networking mechanisms within SHG processes (Tesoriero 2005). Few studies however, have examined the benefits of SHGs beyond group members. Accordingly, research was conducted to look beyond the immediate group processes and outcomes, and examine the impact of SHGs in the wider (local) community.

Factors associated with suboptimal adherence to antiretroviral therapy in Viet Nam: A cross-sectional study using audio computer-assisted self-interview (ACASI)

Background: Optimal adherence to antiretroviral therapy (ART) is necessary for people living with HIV/AIDS (PLHIV). There have been relatively few systematic analyses of factors that promote or inhibit adherence to antiretroviral therapy among PLHIV in Asia. This study assessed ART adherence and examined factors associated with suboptimal adherence in northern Viet Nam. Methods: Data from 615 PLHIV on ART in two urban and three rural outpatient clinics were collected by medical record extraction and from patient interviews using audio computer-assisted self-interview (ACASI). Results: The prevalence of suboptimal adherence was estimated to be 24.9% via a visual analogue scale (VAS) of past-month dose-missing and 29.1% using a modified Adult AIDS Clinical Trial Group scale for on-time dose-taking in the past 4 days. Factors significantly associated with the more conservative VAS score were: depression (p < 0.001), side-effect experiences (p < 0.001), heavy alcohol use (p = 0.001), chance health locus of control (p = 0.003), low perceived quality of information from care providers (p = 0.04) and low social connectedness (p = 0.03). Illicit drug use alone was not significantly associated with suboptimal adherence, but interacted with heavy alcohol use to reduce adherence (p < 0.001). Conclusions: This is the largest survey of ART adherence yet reported from Asia and the first in a developing country to use the ACASI method in this context. The evidence strongly indicates that ART services in Viet Nam should include screening and treatment for depression, linkage with alcohol and/or drug dependence treatment, and counselling to address the belief that chance or luck determines health outcomes.

Self-regulated learning and executive function : exploring the relationships in a sample of adolescent males

This study investigated relationships between SRL and EF in a sample of 254 school-aged adolescent males. Two hypotheses were tested: that self-reported measures of SRL and EF are closely related and that as different aspects of EF mature during adolescence, the corresponding components of SRL should also improve, leading to an age-related increase in the correlation between EF and SRL. Two self-report instruments were used: the strategies for self-regulated learning survey (SSRLS) and the behavioural rating instrument of executive function (BRIEF). Strong correlations between the measures of EF and SRL were found, especially in areas associated with metacognitive processes. Correlations between EF and SRL were found, with weaker correlations between behavioural regulation and SRL were found to be weaker for the younger participants in the sample while the relationship between EF and SRL appears to grow stronger during the initial years of high school even though self-reported levels of EF along with motivation for SRL and important components of SRL such as goal setting and planning were found to decrease with age. Decreasing levels of motivation for learning during adolescence are speculated to moderate the deployment of SRL and EF in a school context.

Sleeping Beauty : global advertising self regulation awakens

The system of self regulation of advertising in mass-media was a dream scenario. If stakeholders complained and the advertisement was deemed offensive by an expert panel, it was an easy matter to withdraw the advertisement from mass media and from public attention. This was done locally, according to the cultural values and aesthetics of the population and the mandate of the self regulation board. To advertising regulators, the internet became their worst nightmare. The system of self regulation was no longer closed, and could be circumvented by placing the offending advertisements online. The system of self regulation was also no longer local, but global. All internet users had access to the same advertisements, regardless of cultural considerations. The awakening of global advertising self regulation is something that demands discussion. It is of value to all conference goers of AAA 2010 Europe, as it affects all advertising academics and all stakeholders in the advertising process. As the leading advertising body seeking to bring global advertising issues to a new venue in Europe, the AAA 2010 European Conference seems ripe for a special session on advertising self regulation. This is especially true as the panel contributes a European, US and Asia-Pacific viewpoint.

“As many options as there are, there are just not enough for me” : a qualitative analysis of contraceptive use and barriers to access among Australian women

There is currently little information available about reasons for contraceptive use or non-use among young Australian women and the reasons for choosing specific types of contraceptive methods. A comprehensive life course perspective of women's experiences in using and obtaining contraceptives is lacking, particularly relating to women's perceived or physical barriers to access. This paper presents an analysis of qualitative data gathered from free-text comments provided by women born between 1973 and 1978 as part of their participation in the Australian Longitudinal Study on Women's Health. The Australian Longitudinal Study on Women's Health is a large cohort study involving over 40,000 women from three age groups (aged 18-23, aged 40-45 and aged 70-75) who were selected from the database of Medicare the Australian universal health insurance system in 1995. The women have been surveyed every 3 years about their health by mailed self-report surveys, and more recently online. Written comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (aged 31-36 years) were examined. Factors relating to contraceptive use and barriers to access were identified and explored using thematic analysis. Side-effects, method satisfaction, family timing, and hormonal balance were relevant to young women using contraception. Most women who commented about a specific contraceptive method wrote about the oral contraceptive pill. While many women were positive or neutral about their method, noting its convenience or non-contraceptive benefits, many others were concerned about adverse effects, affordability, method failure, and lack of choice. Negative experiences with health services, lack of information, and cost were identified as barriers to access. As the cohort aged over time, method choice, changing patterns of use, side-effects, and negative experiences with health services remained important themes. Side-effects, convenience, and family timing play important roles in young Australian women's experiences of contraception and barriers to access. Contrary to assumptions, barriers to contraceptive access continue to be experienced by young women as they move into adulthood. Further research is needed about how to decrease barriers to contraceptive use and minimise negative experiences in order to ensure optimal contraceptive access for Australian women.

Motivations for eWOM exchanges in an online community : self-development, problem solving support, relaxation

Electronic word-of-mouth (eWOM) has gained significant attention from academics and practitioners since it has become an important source of consumers’ product information, which can influence consumer purchase intentions (Cheung & Lee, 2012). eWOM exchanges exist in two types of online communities: online communities of practice and online communities of interest. A few prior studies in online communities of interest have examined members’ motivations for product knowledge exchange (Hung & Li, 2007; Ma & Agarwal, 2007). However, there is a lack of understanding of member motivations for exchanging social bonds and enjoyment in addition to exchanging knowledge pertaining to products in the community. It is important to have an initial comprehension of motivation as an antecedent of these three eWOM exchanges so as to be able to determine the driving factors that lead members to generate eWOM communication. Thus, the research problem "What are the driving factors for members to exchange eWOM in an online community?" was justified for investigation. The purpose of this study was to examine different member motivations for exchanging three types of eWOM. Resource exchange theory and theory on consumer motivation and behavior were applied to develop a conceptual framework for this study. This study focused on an online beauty community since there is an increasing trend of consumers turning to online beauty resources so as to exchange useful beauty product information (SheSpot, 2011). As this study examined consumer motivation in an online beauty community, a web-based survey was the most effective and efficient way to gain responses from beauty community members and these members were appropriate samples from which to draw a conclusion about the whole population. Multiple regression analysis was used to test the relationships between member motivations and eWOM exchanges. It was found that members have different motivations for exchanging knowledge, social bonds, and enjoyment related to products: self-development, problem solving support, and relaxation, respectively. This study makes three theoretical contributions. First, this study identifies the influence of self-development motivation on knowledge exchange in an online community of interest, just as this motivation has previously been found in online communities of practice. This study highlights that members of the two different types of online communities share similar goals of knowledge exchange, despite the two communities evincing different attributes (e.g., member characteristics and tasks’ objectives). Further, this study will assist researchers to understand other motivations identified by prior research in online communities of practice since such motivations may be applicable to online communities of interest. Second, this study offers a new perspective on member motivation for social bonding. This study indicates that in addition to social support from friends and family, consumers are motivated to build social bonds with members in an online community of interest since they are an important source of problem solving support in regard to products. Finally, this study extends the body of knowledge pertaining to member motivation for enjoyment exchange. This study provides a basis for researchers to understand that members in an online community of interest value experiential aspects of enjoyable consumption activities, and thus based on group norms, members have a mutual desire for relaxation from enjoyment exchange. The major practical contribution is that this study provides an important guideline for marketing managers to develop different marketing strategies based on member motivations for exchanging three types of eWOM in an online community of interest, such as an online beauty community. This will potentially help marketing managers increase online traffic and revenue, and thus bring success to the community. Although, this study contributes to the literature by highlighting three distinctive member motivations for eWOM exchanges in an online community of interest, there are some possible research limitations. First, this study was conducted in an online beauty community in Australia. Hence, further research should replicate this study in other industries and nations so as to give the findings greater generalisability. Next, online beauty community members are female skewed. Thus, future research should examine whether similar patterns of motivations would emerge in other online communities that tend to be populated by males (e.g., communities focused on football). Further, a web-based survey has its limitations in terms of self-selection and self-reporting (Bhatnagar & Ghose, 2004). Therefore, further studies should test the framework by employing different research methods in order to overcome these weaknesses.

Feminist ethics and menopause : autonomy and decision-making in primary medical care

The construction of menopause as a long-term risk to health and the adoption of discourses of prevention has made necessary a decision by women about medical treatment; specifically regarding the use of hormone replacement therapy. In a study of general practitioners’ accounts of menopause and treatment in Australia, women's ‘choice’, ‘informed decision-making’ and ‘empowerment’ were key themes through which primary medical care for women at menopause was presented. These accounts create a position for women defined by the concept of individual choice and an ethic of autonomy. These data are a basis for theorising more generally in this paper. We critically examine the construct of ‘informed decision-making’ in relation to several approaches to ethics including bioethics and a range of feminist ethics. We identify the intensification of power relations produced by an ethic of autonomy and discuss the ways these considerations inform a feminist ethics of decision-making by women. We argue that an ‘ethic of autonomy’ and an ‘offer of choice’ in relation to health care for women at menopause, far from being emancipatory, serves to intensify power relations. The dichotomy of choice, to take or not to take hormone replacement therapy, is required to be a choice and is embedded in relations of power and bioethical discourse that construct meanings about what constitutes decision-making at menopause. The deployment of the principle of autonomy in medical practice limits decision-making by women precisely because it is detached from the construction of meaning and the self and makes invisible the relations of power of which it is a part.

Menopause as a long-term risk to health : implications of general practitioner accounts of prevention for women’s choice and decision-making

Over the past two decades medical researchers and modernist feminist researchers have contested the meaning of menopause. In this article we examine various meanings of menopause in major medical and feminist literature and the construction of menopause in a semi-structured interview study of general practitioners in rural South Australia. Three discursive themes are identified in these interviews; (i) the hormonal menopause – symptoms, risk, prevention; (ii) the informed menopausal woman; and (iii) decision-making and hormone replacement therapy. By using the discourse of prevention, general practitioners construct menopause in relation to women's health care choices, empowerment and autonomy. We argue that the ways in which these concepts are deployed by general practitioners in this study produces and constrains the options available to women. The implications of these general practitioner accounts are discussed in relation to the proposition that medical and feminist descriptions of menopause posit alternative but equally-fixed truths about menopause and their relationship with the range of responses available to women at menopause. Social and cultural explanations of disease causality (c.f.Germov 1998, Hardey 1998) are absent from the new menopause despite their being an integral part of the framework of the women's health movement and health promotion drawn on by these general practitioners. Further, the shift of responsibility for health to the individual woman reinforces practice claims to empower women, but oversimplifies power relations and constructs menopause as a site of self-surveillance. The use of concepts from the women's health movement and health promotion have nevertheless created change in both the positioning of women as having ‘choices’ and the positioning of some general practitioners in terms of greater information provision to women and an attention to the woman's autonomy. In conclusion, we propose that a new menopause has evolved from a discursive shift in medicine and that there exists within this new configuration, claiming the empowerment of women as an integral part of health care for menopause, the possibility for change in medical practice which will broaden, strengthen, and maintain this position.

“As many options as there are, there are just not enough for me” : a qualitative analysis of contraceptive use and barriers to access among Australian women

There is currently little information available about reasons for contraceptive use or non-use among young Australian women and the reasons for choosing specific types of contraceptive methods. A comprehensive life course perspective of women's experiences in using and obtaining contraceptives is lacking, particularly relating to women's perceived or physical barriers to access. This paper presents an analysis of qualitative data gathered from free-text comments provided by women born between 1973 and 1978 as part of their participation in the Australian Longitudinal Study on Women's Health. The Australian Longitudinal Study on Women's Health is a large cohort study involving over 40,000 women from three age groups (aged 18-23, aged 40-45 and aged 70-75) who were selected from the database of Medicare the Australian universal health insurance system in 1995. The women have been surveyed every 3 years about their health by mailed self-report surveys, and more recently online. Written comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (aged 31-36 years) were examined. Factors relating to contraceptive use and barriers to access were identified and explored using thematic analysis. Side-effects, method satisfaction, family timing, and hormonal balance were relevant to young women using contraception. Most women who commented about a specific contraceptive method wrote about the oral contraceptive pill. While many women were positive or neutral about their method, noting its convenience or non-contraceptive benefits, many others were concerned about adverse effects, affordability, method failure, and lack of choice. Negative experiences with health services, lack of information, and cost were identified as barriers to access. As the cohort aged over time, method choice, changing patterns of use, side-effects, and negative experiences with health services remained important themes. Side-effects, convenience, and family timing play important roles in young Australian women's experiences of contraception and barriers to access. Contrary to assumptions, barriers to contraceptive access continue to be experienced by young women as they move into adulthood. Further research is needed about how to decrease barriers to contraceptive use and minimise negative experiences in order to ensure optimal contraceptive access for Australian women.

A prospective longitudinal survey of fatigue self-management behaviors in patients with advanced cancer

Background: Fatigue is a distressing symptom experienced by approximately 74-88% of patients with advanced cancer. Although there have been advances in managing fatigue with the use of a range of pharmacologic and non-pharmacologic strategies, fatigue is not well-managed in patients with advanced cancer. Objectives: For patients with advanced cancer, the aims of the study were to examine the self-management (SM) behaviours associated with fatigue; the perceived effectiveness of these SM behaviours, and the socio-demographic and clinical factors influencing the effectiveness of these SM behaviours. Methodology: A prospective longitudinal study was undertaken with 152 patients with metastatic breast, lung, colorectal and prostate cancer experiencing fatigue (>3/10) over a two month period. SM behaviours associated with fatigue, medical/demographic characteristics, social support, depression, anxiety, self-efficacy and other symptoms were assessed. Results: Findings indicate that on most fatigue severity measures, levels of fatigue increased slightly over time. On average, participants used nine fatigue SM behaviours at each time point. Participants reported that the most effective SM behaviours were ‘pacing their activities during the day’, ‘planning activities to make the most of energy’, ‘taking short sleeps’, ‘doing things that distract them from their fatigue’, and ‘doing things to improve sleep at night’. Factors associated with the increased effectiveness of fatigue SM behaviours included higher self-efficacy, higher education level, lower levels of depressive symptoms, and lower functional status. These results can be used to inform the design of future interventions to support the use of effective fatigue SM behaviours in this population.

Governing self : SNSs as tools for self-formation

This thesis investigates how modern individuals relate to themselves and others in the service of shaping their ethical conduct and governing themselves. It considers the use of online social networking sites (SNSs) as one particular practice through which people manage their day-to-day conduct and understandings of self. Current research on the use of SNSs has conceptualised them as tools for communication, information-sharing and self-presentation. This thesis suggests a different way of thinking about these sites as tools for self-formation. A Foucaultian genealogical, historical and problematising approach is applied in order to explore processes of subjectivation and historical backgrounds involved in the use of SNSs. This is complimented with an ANT-based understanding of the role that technologies play in shaping human action. Drawing new connections between three factors will show how they contribute to the ways in which people become selves today. These factors are, one, the psychologisation and rationalisation of modern life that lead people to confess and talk about themselves in order to improve and perfect themselves, two, the transparency or publicness of modern life that incites people to reveal themselves constantly to a public audience and, three, the techno-social hybrid character of Western societies. This thesis will show how some older practices of self-formation have been translated into the context of modern technologised societies and how the care of self has been reinvigorated and combined with the notion of baring self in public. This thesis contributes a different way of thinking about self and the internet that does not seek to define what the modern self is and how it is staged online but rather accounts for the multiple, contingent and historically conditioned processes of subjectivation through which individuals relate to themselves and others in the service of governing their daily conduct.

Incongruence between self-reported and observed senior physical education teaching styles : an analysis using Mosston and Ashworth’s spectrum

Pedagogical styles, methods, models, practices or strategies are valued for what they claim they can achieve. In recent times curriculum documents and governments have called for a range of teaching approaches to meet the variety of learner differences and allow students to make more independent decision making in physical education (Hardy and Mawer, 1999). One well known system of categorizing teaching styles is the Mosston and Ashworth’s Spectrum of Teaching Styles (2002). In Queensland, prior to 2005, no research had been conducted on the teaching styles used by teachers of Physical Education. However, many teachers self-reported that they employed a variety of teaching styles depending on the aims and content of the material to be taught (Cothran, et al., 2005). This research, for the first time, collected teacher’s self-reported use of teaching styles and through observations verify the styles that were being used to teach Senior Physical Education in Queensland. More specifically the aims of the research were to determine: a) What teaching styles teachers of Senior Physical Education in Queensland believe they use? i) Were they using a range of teaching styles? ii) Were teachers of Senior Physical Education in Queensland using teaching styles that the Queensland Senior Physical Education Syllabus (2004) required? b) If Mosston and Ashworth’s (2002) Spectrum of Teaching Styles were used to categorise styles observed during the teaching of Senior Physical Education did the styles being used provide opportunities for evaluating as described by the Queensland Senior Physical Education Syllabus (2004)? The research was conducted in two phases. Part A involved use of a questionnaire to determine the teaching styles Queensland teachers of Senior Physical Education reported using and how often they reported using them. The questionnaire was administered to 110 teachers throughout Queensland. The sample was determined from 346 schools teaching Senior Physical Education (in 2006) across the state of Queensland, Australia. 286 questionnaires were sent to 77 non-randomised schools. There were 66 male and 44 female respondents in the sample. A wide range of teaching styles were reportedly used by teachers of Senior Physical Education with Practice Style-Style B, Command Style-Style A and Divergent Discovery Style-Style H, the most reportedly used. The Self-Teaching Style-Style K was reportedly used the least by teachers involved in this study. From the respondents a group of teachers were identified to form the participants for Part B. Part B of the study involved observation of a group of volunteer participants (from those who had completed the questionnaire) who displayed many of the ‘typical’ characteristics, and a cross-section of backgrounds, of teachers of Senior Physical Education in Queensland. In the case of this study, the criteria used to select the group of teachers to be observed teaching were, teaching experience (number of years: 0-4, 5-10 and 11 years and over), gender, geographical location of schools (focused on Brisbane and near area for travel/access purposes), profile of the students at schools (girls, boys or co-educational), nature of school (Government or Private) and the physical activities being taught in a school (activities to reflect all the areas of physical activity outlined within the syllabus). A total of 27 questionnaire respondents from Part A indicated that they were willing to be observed teaching practical lessons. The respondents who volunteered to be involved in Part B of the study came from different regions across the state of Queensland and was not confined to the Brisbane metropolitan area or large cities. From the group of people who volunteered for Part B four came from outside Brisbane and 23 from the Brisbane area. The final observation group of nine participants included eight teachers from the Brisbane area and one from a rural area. The characteristics of the final group included three females and six males from private and public schools with a range of teaching experience in years and a range of physical activities. Four year 12 and five year 11 teachers and their classes were videoed on three occasions as they progressed through an eight – nine week unit of work. This resulted in 24 hours 48 minutes and 20 seconds (or 4465 observations) of video teaching data which was subsequently coded by several researchers (99% interobserver reliability) to determine the teaching styles employed by the participants. This research indicated that, based on Mosston and Ashworth’s (2002) Spectrum of Teaching Styles, teachers of Senior Physical Education in Queensland used predominantly one style to teach 27 observed lessons. This is in sharp contrast to the variety of styles 110 teachers self- reportedly used and in spite of the Queensland Senior Physical Education Syllabus (2004) suggesting a range of specific styles be used. These results are discussed in the context of the Queensland Senior Physical Education Syllabus (2004), teacher knowledge of teaching styles and high-stakes curriculum and external pressures such as national testing and the publication of data from schools in tabloid newspapers. The data and findings in this research provide a rationale for improving teacher knowledge regarding teaching styles and the need for a clear definition of terminology in syllabus documents. Careful examination of the effects that the publishing of school data may have on teaching styles is advised. This research not only collected teacher’s perceptions of the teaching styles they believed they used it also verified these claims through direct observations of the teachers while teaching. These findings are relevant to syllabus writers, teacher educators, policy makers within education and teachers.